THE SOCIO-CULTURAL CONTEXT OF MATERNAL HEALTH IN LAGOS STATE, NIGERIA
ABSTRACT
Maternal health is one of the major concerns of the global health community. Pregnancy- related mortality is avoidable if preventive measures are taken and adequate care is available. Yet women in sub-Saharan Africa continue to die due to pregnancy-related complications.
This study set out to examine the socio-cultural context of pregnant women and how that context precipitates maternal morbidity and mortality. The study was prompted by the high rate of maternal death despite all efforts and the observation that studies had concentrated on the proximate determinants of maternal mortality, rather than also considering the social determinants.
Five objectives were considered which were to: identify the social factors that precipitate the medical proximate determinants of maternal health, determine the cultural beliefs and stereotypes that are associated with maternal health, examine how role conflict influences maternal health, investigate how mothers’ working conditions affect maternal health, and evaluate how social support influence maternal health.
Systematic review of literature was carried out while the study utilized Functionalism, Agency Structure Theory and Gender and Development (GAD) Theory for its theoretical framework.
The study was conducted in the four selected Local Government Areas (LGAs) of Lagos State from November, 2011to January, 2012 using 1,362 respondents to whom a structured questionnaire was administered, 20 key informants were interviewed and 4 case studies were analysed.
Five hypotheses were tested. The first hypothesis revealed age, education, occupation, income, religion, marital status and type of marriage are significant determinants of maternal health complications.
Women in age group 20-24, 25-29 and 30-34 are 0.631, 0.621 and 0.756 respectively less likely to have health complications. The second hypothesis estimated significant influence of cultural beliefs and practices on maternal health. With p-values 0.021, 0.001, 0.050 and 0.011 respectively, women who experience swollen feet, dizziness, fatigue or more than one of these symptoms are more likely to be at risk of complication.
The third hypothesis also indicated a significant influence of role conflict on maternal health. Women’s working conditions were found to significantly influence maternal health complications in the forth hypothesis. And the finding of the fifth hypothesis revealed that there is a significant influence of social support available to women on maternal health. The findings presented in this study show that maternal health
challenges will continue to shape national indicators on health, poverty, and other development issues, if adequate attention is not provided.
The study suggests that to reduce maternal morbidity and mortality, intervention programmes must be introduced to deal with maternal health in a broad and multidimensional way. Every effort must be put in place to reduce poverty and enhance infrastructural development.
Health promotion and education should be widely recognized and should be embarked upon as necessary primary approaches to ensure maternal health. Health policies toward maternal wellbeing during pregnancy in the place of work should be developed in the light of urban poor infrastructure. There must be a strong political will to help in the process of reducing maternal mortality in Nigeria.
Keywords: Socio-cultural, Maternal health, Complications, Lagos.
LIST OF ABBREVIATIONS EOC Emergency Obstetric Care HEFAAMA Lagos State Health Facility Monitoring and Accreditation Agency HDR Human Development Report ICD International Classification of Diseases ICM International Conference of Midwives ICRW International Centre for Research on Women MMR Maternal Mortality Rate NDHS Nigeria Demographic and Health Survey NPCN National Population Commission Nigeria PHC Primary Health Care TBA Traditional Birth Attendant UN United Nations UNDP United Nations Development Program
UNFPA United Nations Fund for Population Activities UNICEF United Nations Children Fund
USAID United States Agency for International Development WHO World Health Organization
1.1 Background to the study
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CHAPTER ONE
INTRODUCTION
The growing concern on improving reproductive health in the global south has created a demand for research especially in the area of maternal health. Maternal health, which is the physical well being of a woman during pregnancy, childbirth, and postpartum period (WHO, 2011; Fadeyi, 2007), has been a major concern of several international summits and conferences since the late 1980s, which culminated to the Millennium Summit in 2000 (WHO, 2007).
At that summit, it was generally agreed that maternal health care has a crucial role to play in the improvement of reproductive health and that women deserve to be well informed and empowered to have unhindered access to safe, effective, affordable, acceptable and appropriate health care service.
These will enable them to go safely through pregnancy and child birth and provide couples with the best chance of having healthy infants (United Nations, 1996). While motherhood is often a positive and fulfilling experience, for
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